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Long term service award nomination form

To be considered by the NBoD, nominations must be submitted 30 days prior to any NBoD meetings – complete with endorsement from the Component or REVP – to the PSAC Executive Office. Nominating bodies require time to review applications, so earlier submission is advisable.

Record in chronological order positions held in PSAC over 10 year period (breaks not to exceed three months). If more than three months, an explanation is required as per item 3 of the criteria.
Complete one line for each position held. Click "Add more" to list additional positions.

From

To

Position Held

Local, Component, DCL

From *

Month

Day

Year

To *

Month

Day

Year

Position Held *

Local, Component, DCL *

Other information

Nominator

Name *

Position *

Nominator Email *

Seconder

Name *

Position *

Seconder Email *

Verifier

The person from the component national office or Directly Chartered Local supporting this nomination